School Nurse Intervention and After School Exercise Program for Overweight Teens

• Body Mass Index (BMI) [ Time Frame: One academic year (8 months) ] [ Designated as safety issue: No ]
  Lookin Good Feelin Good (LGFG) program participants will achieve greater reduction in BMI z-scores than Information attention control (IC) participants after one academic year (8 months) of intervention
• Participation in exercise program [ Time Frame: One academic year (8 months) ] [ Designated as safety issue: No ]
  LGFG participants will report greater than 90% adherence to intervention protocol by school nurses on Patient Exit Interview (PEI) checklists following each of the 6 visits and will attend at least 75% of the exercise sessions.

• Self-management [ Time Frame: One academic year (8 months) ] [ Designated as safety issue: No ]
  LGFG participants will report greater improvements in dietary quality, physical activity and sedentary behavior than IC participants at 8 month follow-up, as measured by 24-hour dietary recall (24HDR), accelerometers, and measures of specific diet, physical activity and sedentary behaviors targeted by the intervention. Improvements will mediate the relationship between condition and BMI.
• Physiologic outcomes [ Time Frame: One academic year (8 months) ] [ Designated as safety issue: No ]
  To evaluate the effect of the LGFG compared to IC condition on changes in secondary physiologic outcomes, including waist circumference, estimate of body fat, and blood pressure.
• Psychosocial outcomes [ Time Frame: One academic year (8 months) ] [ Designated as safety issue: No ]
  To evaluate the effect of the LGFG compared to the IC condition on changes in psychosocial outcomes including self-efficacy, quality of life, and depression.

Adolescent overweight and obesity have increased dramatically in the past several decades. High schools are well-positioned to deliver weight loss treatment to overweight and obese adolescents, as they have the facilities and staff to deliver a physical activity program, school nurses with the skills to provide counseling, and are easily accessible by adolescents. This exploratory study will test the feasibility and ability of a school-based intervention, consisting of school nurse counseling and a school-based exercise program, to reduce BMI and improve dietary quality, physical activity, and sedentary behaviors in overweight and obese adolescents. If effective, this could prove to be a cost-effective and relatively easy intervention to disseminate widely for significant public health impact.

• Overweight
• Obesity

• Behavioral: Lookin' Good Feelin' Good
  Six 30-minute individual student-centered counseling sessions delivered by school nurses during the first two months followed by weekly weigh-ins and monthly visits over the subsequent 6 months, plus an exercise program in the school 3 times a week for the full eight months of the intervention.
• Behavioral: Information attention-control
  Six individual sessions with school nurse over the first two months followed by monthly visits over the remaining 6 months to check weight and behavior changes and provide a series of pamphlets on weight and weight management.

• Experimental: Lookin' Good Feelin' Good
  Six 30-minute individual student-centered counseling sessions delivered by school nurses during the first two months followed by weekly weigh-ins and monthly visits over the subsequent 6 months, plus an exercise program in the school 3 times a week for the full eight months of the intervention.
  Intervention: Behavioral: Lookin' Good Feelin' Good
• Active Comparator: Information attention-control
  Six individual sessions with school nurse over the first two months followed by monthly visits over the remaining 6 months to check weight and behavior changes and provide a series of pamphlets on weight and weight management.
  Intervention: Behavioral: Information attention-control

Inclusion Criteria:

• enrolled in grades 9 - 12
• BMI > 85th percentile for age/sex
• able to understand and participate in the study
• able and willing to provide informed assent (adolescent) and consent (parent)
• English-speaking with at least one English-speaking parent

Exclusion Criteria:

• planning to move out of the area within the next 8 months
• medical condition that precludes adherence to study dietary recommendations (e.g., pregnancy, Crohn's disease, ulcerative colitis)
• diagnosis of a serious psychiatric illness (e.g., psychiatric hospitalization, eating disorder, suicidal) within the past 5 years
• genetic or endocrine causes of obesity (e.g., pradi Willi, Cushing's Syndrome)
• developmental delay that would prevent participation in the intervention or measurements
• prescribed medications associated with weight gain (e.g.,oral steroids)
• morbidly obese, defined as weighing > 300 pounds